Value of Burr-Hole Surgery as an Adjunct to Encephaloduroarteriosynangiosis in Treatment of Adult Moyamoya Disease: A Case Series

被引：2

作者：

Khorasanizadeh, MirHojjat ^{[1
]}

Mizuhashi, Satomi ^{[1
]}

Ogilvy, Christopher S. ^{[1
]}

Moore, Justin ^{[1
]}

Thomas, Ajith J. ^{[1
]}

机构：

[1] Harvard Med Sch, Neurosurg Serv, Beth Israel Deaconess Med Ctr, 110 Francis St, Boston, MA 02115 USA

来源：

STROKE-VASCULAR AND INTERVENTIONAL NEUROLOGY | 2022年 / 2卷 / 02期

关键词：

case series; combined surgery; encephaloduroarteriosynangiosis; moyamoya disease; multiple burr-hole surgery; neovascularization; SURGICAL-TREATMENT; PLASMINOGEN-ACTIVATOR; ISCHEMIC-STROKE; REVASCULARIZATION; THROMBECTOMY; ARTERY; GUIDELINES; OCCLUSION; OUTCOMES; UPDATE;

D O I：

10.1161/SVIN.121.000242

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

BACKGROUND: Using a single indirect revascularization technique in adult patients with moyamoya disease has been associated with inconsistent outcomes. Herein, we aimed to describe treatment outcomes following combined encephaloduroarteriosynangiosis plus burr-hole surgery (BHS) in adult moyamoya disease. METHODS: Encephaloduroarteriosynangiosis combined with 1 anterior and 1 posterior burr hole per hemisphere was performed in 16 adults with moyamoya disease who presented to our center between 2013 and 2019. Patients were followed with clinical reassessments and cerebral angiograms to evaluate for neovascularization. RESULTS: Combined encephaloduroarteriosynangiosis and BHS procedures were performed on 24 hemispheres in 16 patients. Follow-up ranged from 9 to 57 months, during which no new ischemic or hemorrhagic events, perioperative or long-term complications, or deterioration of symptoms was observed. Follow-up angiography showed evidence of additional neovascularization provided by the burr holes in 18 of the 24 hemispheres. Of 9 hemispheres with poor revascularization response to encephaloduroarteriosynangiosis, 5 achieved neovascularization at the burr-hole sites. Older age, smoking, and cerebral infarction or hemorrhage on preoperative magnetic resonance imaging tended to correlate with absence of neovascularization following BHS. CONCLUSIONS: BHS is a simple and safe procedure that can be done simultaneously with other indirect or direct revascularization procedures. It can provide additional neovascularization even in patients unresponsive to encephaloduroarteriosynangiosis (EDAS) and can be tailored to improve the blood flow in any vascular territory that may not be properly covered by standard revascularization procedures. We find value in adding BHS as an adjunct to other indirect or direct revascularization techniques such as encephaloduroarteriosynangiosis for treatment of adult moyamoya disease.

引用

页数：10